Malone University



2017–2018 Verification Worksheet

Dependent Student

|Your 2017-2018 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that before awarding Federal |

|Student Aid, we may ask you to confirm the information you and your parents reported on your FAFSA. To verify that you provided correct information the financial aid |

|administrator at your school will compare your FAFSA with the information on this worksheet and with any other required documents. If there are differences, your FAFSA |

|information may need to be corrected. You and at least one parent must complete and sign this worksheet, attach any required documents, and submit the form and other |

|required documents to the financial aid administrator at your school. Your school may ask for additional information. If you have questions about verification, contact |

|your financial aid administrator as soon as possible so that your financial aid will not be delayed. |

Dependent Student’s Information

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Student’s Last Name Student’s First Name Student’s M.I.

______________________________________________________________ ___________________________________

Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone #

Dependent Student’s Family Information

List below the people in your parent(s)’ household. Include:

▪ Yourself and your parent(s) (including a stepparent) even if you don’t live with your parent(s).

▪ Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2017, through June 30, 2018, or if the other children would be required to provide parental information if they were completing a FAFSA for 2017–2018. Include children who meet either of these standards, even if they do not live with your parent(s).

▪ Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will continue to provide more than half of their support through June 30, 2018.

Include the name of the college for any household member, excluding your parent(s), who will be enrolled, at least half time in a degree, diploma, or certificate program at a postsecondary educational institution any time between July 1, 2017, and June 30, 2018. If more space is needed, attach a separate page with the student’s name and Social Security Number at the top.

|Full Name |Age |Relationship |College |Will be Enrolled at Least |

| | | | |Half Time |

|Missy Jones (example) |18 |Sister |Central University |Yes |

| | |Self | | |

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Dependent Student’s Income Information to Be Verified

You must submit a signed copy of your 2015 Federal 1040 income tax return. Important Note: If the student filed an amended 2015 IRS tax return, you must also submit a signed copy of your 1040X.

If the student was not required to file a federal tax return, check the box that applies:

The student was not employed and had no income earned from work in 2015.

The student was employed in 2015 but was not required to file a federal tax return. List below the names of all the student’s employers, the amount earned from each employer in 2015, and whether an IRS W-2 form is attached. Attach copies of all 2015 IRS W-2 forms issued to the student by employers. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attach a separate page with the student’s name at the top.

|Employer’s Name |2015 Amount Earned |IRS W-2 Attached? |

|Suzy’s Auto Body Shop (example) |$2,000.00(example) |Yes(example) |

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Parent’s Income Information to Be Verified - If two parents were reported on the FAFSA, the instructions and certifications below refer and apply to both parents.

You must submit a signed copy of your parent(s) 2015 Federal 1040 income tax return. Important Note: If the student’s parent(s), filed or will file, an amended 2015 IRS tax return, parents must also submit a signed copy of their 1040X.

Check the box that applies:

The parent(s) was not employed and had no income earned from work in 2015.

The parent(s) was employed in 2015 but was not required to file a federal tax return. List below the names of all the parent’s employers, the amount earned from each employer in 2015, and whether an IRS W-2 form is attached. Attach copies of all 2015 IRS W-2 forms issued to the parent(s) by employer(s). List every employer even if they did not issue an IRS W-2 form. If more space is needed, attach a separate page with the student’s name at the top.

|Employer’s Name |2015 Amount Earned |IRS W-2 Attached? |

|Suzy’s Auto Body Shop (example) |$2,000.00 (example) |Yes (example) |

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Parent’s Other Information to Be Verified

1. Complete this section if one of the student’s parents paid child support in 2015.

One (or both) of the student’s parents listed in Section B of this worksheet paid child support in 2015. The parent has indicated below the name of the person who paid the child support, the name of the person to whom the child support was paid, the names of the children for whom child support was paid, and the total annual amount of child support that was paid in 2015 for each child. If asked by the school, I will provide documentation of the payment of child support. If you need more space, attach a separate page that includes the student’s name and Social Security Number at the top.

|Name of Person Who Paid Child Support |Name of Person to Whom Child Support |Name of Child for Whom Support Was|Age of the |Amount of Child |

| |was Paid |Paid |Child |Support Paid in 2015 |

|Marty Jones |Chris Smith (example) |Terry Jones | |$6,000.00 |

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Certification and Signatures

Each person signing this worksheet certifies that all of the

information reported on it is complete and correct.

The student and one parent must sign and date.

_________________________________________________ _________________________________

Student’s Signature Date

_________________________________________________ _________________________________

Parent’s Signature Date

Return completed form to:

Malone University

Financial Aid Office

2600 Cleveland Ave. N.W.

Canton, OH 44709

Fax number 330-471-8652

finaid@malone.edu

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WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.

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